Registration Form – Michael Feldman – Núcleo Português de Psicanálise

Dr. Michael Feldman

Clinical Seminar in Lisbon | 26th to 27th October 2018

Registration Form

Name

Address

Profession

Telephone

E-mail

Society/Institution

Payment Method

Payment by Bank Transfer

BANCO SANTANDER TOTTA, S.A.
Hospital Sta. Maria. Av Egas Moniz, 1600-035 Lisboa-Portugal
Teresa Flores - Clinical Seminar
Account: 000346997151020 31 BT
NIB: 0018000346997151020 83
IBAN: PT500018000346997151020 83
Swift Code/BIC:TOTAPTPL

VAT Number/NIF

Registration Fee - Before 30 September

For Psychoanalysts ONLY (26th and 27th) - 150€

For Candidates/Medical Doctors/Psychologists (ONLY October 26) - 50€

Registration Fee - After 30 September

For Psychoanalysts ONLY (26th and 27th) - 170€

For Candidates/Medical Doctors/Psychologists (ONLY October 26) - 70€

Please upload a copy of the payment

Upload a copy of the payment

Registration will be confirmed by email upon receipt of completed form and corresponding payment copy. No refund will be available.

Registration Form – Michael Feldman

Dr. Michael Feldman

Clinical Seminar in Lisbon | 26th to 27th October 2018 Registration Form

Clinical Seminar in Lisbon | 26th to 27th October 2018

Registration Form